Endoscopic Retrograde Cholangiopancreatography in Nonagenarian Patients: Is It Really Safe?

Abstract

Background/AimsLiterature on the safety of endoscopic retrograde cholangiopancreatography (ERCP) in elderly patients is divided. Based on this we decided to examine the safety of ERCP in nonagenarian patients.MethodsA total of 1,389 patients, with a mean age of 63.94±19.62 years, underwent ERCP during the study period. There were 74 patients aged 90 years or older with a mean age of 92.07±1.8. Logistic regression showed that nonagenarian patients had a significantly increased odds of in-patient mortality (adjusted odds ratio [AOR]=9.6; 95% confidence interval [CI]=4, 23; p≤0.001). Charlson Comorbidity Index (CCI) ≥2 was also an independent predictor of in-patient mortality (AOR=2.4; 95% CI=1.2, 5.2; p=0.021). Age ≥90 was not associated with increased adverse events; however emergency procedures (AOR=2.4; 95% CI=1.5, 4; p<0.001) and CCI ≥2 (AOR=2.6; 95% CI=1.7, 4.0; p<0.001) were more likely to have adverse events. ConclusionsAge ≥90 and CCI ≥2 are independently associated with increased odds of in-patient mortality in patients undergoing ERCP, whereas emergency procedures and CCI ≥2 are associated with an increased adverse event rate. Caution must be exercised when considering ERCP in patients aged ≥90 years and those with a CCI ≥2.

Is complete stone removal for choledocholithiasis always necessary in extremely elderly patients?

“…[13][14][15][16][17] In the present study, the adverse event rate was 11% (8/73). Although elderly patients have multiple diseases and functional disorders, ERCP appears to be a safe and effective method even in very old patients.…”

“…Zain et al 17 reported an all-cause inpatient mortality rate of 12.2%, and Mitchell et al 18 reported an all-cause inpatient mortality rate of 13%. No other study has reported long-term OS after ERCP in nonagenarian patients, although a few studies mentioned the mortality rate.…”

Risk factors of adverse events in endoscopic retrograde cholangiopancreatography for patients aged ≥85 years

“…Further, although several studies have reported that ERCP was safe in patients aged ≥90 years, the control groups in several of them included younger patients. [10][11][12] In a recent retrospective study, the ERCP mortality rate increased in the super-old (those aged ≥90 years), but the AE occurrence rate was not significantly different compared with those aged <90 years 13 . We aimed to identify factors contributing to AE in ERCP in patients aged ≥85 years and to examine whether ERCP is safe in the super-old.…”

Endoscopic Retrograde Cholangiopancreatography in elderly patients: A safe choice in sepsis

“…Complications have been observed during the early postoperative period in 1.6% of patients older than 90 years [ 2 , 3 ]. In a retrospective single-center study conducted by Sobani et al [ 4 ] performed with 1389 patients, 74 patients were ≥90 years of age, and the success rate of ERCP was 89.2%. The authors emphasized the safety of this procedure, even in this age group, provided that the necessary preparation is performed.…”